Health systems

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Global commitment to improving health outcomes, especially for the world’s most vulnerable populations, and to meeting the health-related Millennium Development Goals has never been stronger. However, since the goals were agreed in the year 2000, the persistence of communicable diseases, the effects of long-term under-investment, the impact of the HIV epidemic and a range of other health challenges have all conspired to stall progress.

One response has been the emergence of the Global Health Initiatives (GHIs). These initiatives have been successful in dramatically raising the level of resources for health, in part because of their selective focus on specific diseases, products or populations. However, in a vicious circle, weak health systems have constrained the delivery capacity of the GHIs while the selective approach of the GHIs has also, in some cases, had the unintentional effect of further eroding the capacity of health systems. This dilemma has prompted a heightened commitment from all stakeholders to broader health systems strengthening and to better integrating the efforts of GHIs and health systems.

There is little doubt that positive synergies exist between health systems and the GHIs. But are these synergies being vigorously exploited by all stakeholders to ensure maximum, mutual added value? Or are new opportunities for improved public health outcomes in low- and middle-income countries being missed?

Since its launch in May 2008, the Positive Synergies research effort has engaged stakeholders and researchers worldwide in a collaborative endeavour to build new knowledge on the interactions between global health initiatives and national health systems. As global health partners focus on innovative ways to increase financing for health systems and to harmonize existing funding approaches, it will be critical to develop a clearer understanding of how best to accelerate health progress and direct resources strategically.